There was a post in today’sHealthAffairs Blog (see links at the end of this post) with some helpful insights on the importance of affordable housing as a key element of being able promote and sustain healthy aging. I have written rather extensively over the years in this space on this topic, and I have long been an advocate for Affordable Housing Plus Services.

I don’t recall if I’ve shared this here before or not, but I once had the opportunity to ask directly a former Secretary of Health & Human Services why there wasn’t more effective communication and coordination of policy initiatives between HHS and HUD. The response was unflattering: that was a great idea without a plausible explanation for why it had not been actively pursued. Thus be to bureaucracy.

If I could build upon the major policy themes pointed out in the HA post, something I have learned over the past five years is that a primary reason acute care providers struggle to understand post-acute care is because post-acute care is a lot more complicated than I understood. And, of course, I make that observation somewhat tongue-in-cheek because that’s all I’ve done for the past two decades.

But this article reminded me again how complex post-acute/long-term care can be. And that’s because it’s not just about providing good healthcare. It’s very much about where that healthcare is going to be provided (in what structure does the patient live). It’s about what support services are available to assist the patient with activities of daily living (in what community does the patient live). It’s about hospitality and entertainment (who wants the sole focus of their life to be an illness?) And it’s about insurance because most often care providers and/or insurers are underwriting extended care for which it is often difficult to predict duration, complexity and cost.

The same fundamental attributes that make it a complex delivery model make it a complex policy issue. Acute care providers are being more intimately connected with post-acute care providers every day through healthcare public policy initiatives. My counsel is they would do well to begin understanding the root causes of what makes post-acute and long-term care more complex than they may have realized.

. . . or not.The Associated Press-NORC Center for Public Affairs Research last week released the report, Perceptions, Experiences and Attitudes among Americans 40 or older. Sponsored by the SCAN Foundation, the report presents research based upon interviews of just over 1,000 individuals aged 40 and older regarding their views on aging.

From a public policy perspective, the key takeaway underscores a phenomenon common to discussion and debate over how to finance the future long-term care needs of an aging population. At a time in our lives when we are at our peak earning potential we typically also have the highest propensity to spend – quite often as a necessity of family survival. The past half-decade has heightened further that reality for many of us.

Of those interviewed, fully 30% would rather just not think about aging – while an additional 32% were only somewhat comfortable thinking about getting older. Not surprisingly, there was an apparent correlation between being more comfortable (I would posit, willing) to think about and discuss aging and the respondent’s age. Ailments and infirmities tend to be quite effective at breaking down one’s belief in mind over matter as a plausible substitute for the elusive fountain of youth.

In what I interpret as a perceptual vote of no confidence in government’s ability to effectively address the looming cost crisis attendant to long-term care, 51% of interviewees between the ages of 40 and 54 – and 48% between the ages of 55 and 64 – are a great deal or quite a bit concerned about affording the long-term care they may require as they age. This is compared to only 30% of those over the age of 65 (i.e., Medicare eligible) who share the same concern.

Whether that represents a false sense of security or not, it is worth noting the research also highlighted the continuing misperceptions that many individuals have regarding their probability of needing future long-term care, its costs, programs available to provide assistance and how to plan for future needs. For those directly involved in providing long-term care services and support those perceptions are accepted realities. But for those in positions of public policy influence and responsibility the consequential understanding of those realities is a lot less clear.

Of course, I am thinking of the Commission on Long-Term Care, which pursuant to Section 643 of the Taxpayer Relief Act, is charged with developing, “a plan for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports for individuals in need of such services and supports, including elderly individuals, individuals with substantial cognitive or functionallimitations, other individuals who require assistance to perform activities of daily living, and individuals desiring to plan for future long-term care needs.”"

There is widespread belief that a key element of any successful plan should include efforts to create greater awareness and education surrounding the individual realities of long-term care. The research shared above serves to underscore that belief. What is largely unknown, however, is whether such investments are worthwhile. We have so far seen the relatively disappointing results of investments in health and wellness (as an aside, I wonder whether Senator Harkin has seen that research).

Sometimes things that seem to be intuitively correct are disproved by empirical evidence. The failure of long-term care insurance to gain greater traction may be an indicator that education and awareness regarding the need to plan for long-term care will have a limited ability to overcome the strong human inclination to stay in the moment.

Since it is also true, however, that intuition often bears fruit only through successive efforts to overcome obstacles, I do believe education and awareness, along with wellness and prevention, should continue to be encouraged from a healthcare and long-term care public policy perspective. In making those investments, however, programs with tighter feedback loops that help measure relative effectiveness are not only prudent but will help accelerate the desired outcomes of those investments.